The proposed project represents an exciting opportunity to engage older urban African Americans in a comparative effectiveness study of methods to increase CRC screening. African American participants represent only about 25% of study participants in the parent study. As a result, we will not be able to determine the impact of different intervention methods in this high-risk group. Determining how to increase CRC screening among African Americans will help to reduce disparities in disease incidence and mortality. In this competitive revision, the patient population for the study will be drawn from Einstein Health System primary care practices in Philadelphia that serve a predominantly African American patient population. Using a two-group randomized design, we will randomly assign consenting participants who complete a baseline telephone survey (N=472) to either a Standard Intervention (SI) Group (N=236) or an Enhanced Tailored Navigation Intervention (E-TNI) Group (N=236). SI Group participants will receive a generic mailed intervention that encourages CRC screening. E-TNI Group participants will receive a mailed intervention that is culturally-targeted to African Americans, telephone contacts, and electronic communications intended to encourage CRC screening. Specific aims of the study, in order of priority, are to determine (1) E-TNI impact on CRC screening utilization, (2) E-TNI impact on CRC screening preference, and (3) E-TNI impact on perceptions about CRC screening. We hypothesize that the E-TNI Group will have significantly higher CRC screening use, increased preference for CRC screening, and more favorable perceptions about CRC screening than the SI Group. Data obtained from an endpoint survey and an endpoint chart audit will be used to assess study group differences. PUBLIC HEALTH RELEVANCE: The proposed competitive revision represents an exciting opportunity to engage older urban African Americans in a comparative effectiveness study of methods to increase CRC screening. Determining how to increase CRC screening among African Americans will help to reduce disparities in disease incidence and mortality.